Inspection·June 20, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm noted, no complaint of pain when swallowing noted, and no pain or hurting at any time in the last 5 days noted. Skilled nurses notes, dated 06/08/23, revealed at 09:08 (09:08 a.m.) no chest pain noted, no complaint of pain when swallowing noted, and no pain or hurting at any time in the last 5 days noted. Skilled nurses notes, dated 06/09/23, revealed at 08:44 (08:44 a.m.) no chest pain noted, no complaint of pain when swallowing noted, and no pain or hurting at any time in the last 5 days noted. Residents Affected - Few Interview on 06/20/2023 at 10:52 a.m., ADM revealed when Resident #1 admitted to the facility, family was asked to bring Resident#1's patches from home, 5 patches were brought to the facility. Further into the interview, ADM revealed the time of Resident #1's discharge, her fentanyl patches were not received, she communicated with the MD for orders to fill Resident#1's orders for fentanyl, ADM confirmed orders were made, although since Resident #1 had already discharged from the facility, orders that are sent to the pharmacy will cease and the pharmacy can no longer fulfill the order. ADM stated she could have been clearer with the pharmacy and inform of Resident #1's plan to go home, ADM stated that there was a break in communication. Interview on 06/20/2023 at 12:59 p.m., MD revealed that orders for Resident #'s fentanyl patches were started on 05/19/2023, Resident #1 was to receive 10 patches equaling a month supply for Resident #1. MD revealed he monitored Resident #1's orders and found out only one patch was delivered. MD revealed that there was more than likely chance the pharmacy did not fulfill the order as Resident #1's PCP wrote an order on 04/25/2023 and was filled on 04/29/2023 for 10 patches, this should have lasted Resident #1 until 05/29/2023. MD revealed that the pharmacy was more than likely monitoring the Texas PMP (prescription monitoring program) as they track controlled medications. MD confirmed Resident #1 has orders for hydrocodone oral tablet 5-325 MG give 1 tablet by mouth every 8 hours for pain should alleviate pain. MD revealed that when he assessed Resident #1 on 06/01/20233 and 06/08/2023, no complaints of pain were noted, and there were no objective indications of pain. MD revealed the hydrocodone could alleviate pain. Interview on 06/20/2023 at 01:58 p.m., DON stated when Resident #1 admitted , family was asked to bring in the remaining amount of fentanyl patches filled by Resident #1's Primary Care Provider. DON confirmed that Resident #1 did not receive her scheduled fentanyl patch on 06/07/2023 as they were out of patches. DON revealed that Resident #1 did receive all orders including the hydrocodone, having supplemented for her fentanyl patches. Interview on 06/20/2023 at 02:05 p.m., the pharmacy representative confirmed Resident #1's did not send her complete order of fentanyl patches as it was filled on 04/31/2023 by the community PCP. An order was received for Resident #1 while she admitted to the facility on [DATE], the order was not fulfilled due to the Texas PMP (prescription monitoring program), as they track controlled medications, the pharmacy representative revealed that they sent one patch for Resident #1.The pharmacy representative stated that the day Resident #1 discharged ADM called to refill the order, the reorder process started, although by the end of the day Resident #1 discharged . The pharmacy representative stated, in their system utilized when a resident has discharged , all orders cease. The pharmacy representative stated in most cases a facility could use its electronic medical records to submit orders, the pharmacy representative also stated that if the orders were received in a timely manner, they would have fulfilled the remaining order initiated on 05/19/2023 and sent the 9 remaining patches as the first fentanyl patch had been filled. Review of the facility's policy ordering medication, no date, revealed medications and related product are received from pharmacy supplier on a timely basis. Medications orders are phoned or faxed to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676014 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676014 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twilight Home 3001 W Fourth Ave Corsicana, TX 75110 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 the pharmacy, reorder medication three to four days in advance of need to assure an adequate supply is on hand. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676014 If continuation sheet Page 3 of 3